Summary of Ted Talk: Maternal Death: a century of getting it wrong. – by Dr Basky Thilaganathan

Preeclampsia – is a condition responsible for one in five maternal deaths. It’s a complication that results in very high blood pressure. First described in 500 BC

  • Traditionally it has been blamed on the placenta – the placental hypothesis states that the baby grows ineffectively as well as the micro-issues seen in the tissue a swell as removing the placenta relieves the preeclampsia.
  • The heart and placenta work like a pump and a radiator – the radiator/placenta needs the heart/pump to work well and vice versa

Dr Basky Thilaganathan thinks there is a different underlying root cause:

  • Most women in fact did not have anything wrong with the placenta and had babies normal in size. But you do have to have a placenta to develop it.
  • Women who develop preeclampsia are 5 times more likely to develop heart disease or stroke in the subsequent 20-30 years.
  • In fact, 2 out of 3 women who develop preeclampsia will die from heart disease.
  • So the question is how does the placenta that was removed 20-30 years ago have such a profound effect on the mothers heart??
    • Dr Thilaganathan started to see parallels with another disease that devlops in pregnancy – Gestational Diabetes – the mothers pancreas is unable to deal with the sugar load of pregnancy so diabetes occurs – interestingly diabetes in pregnancy is cured by delivery of the baby as well. But women who develop diabetes in pregnancy have 50% increased risk of developing diabetes in the subsequent 10 years.

So it seems logical that preeclampsia is a condition that has nothing to do with the placenta and rather that the issue is that the mothers heart is unable to deal with the vascular load of pregnancy.

Heart Facts:

  • Did you know that a young elite athlete taking on a training load will increase the weight of her/his heart 25% over a 2-year period.

Pregnancy Heart Facts:

  • During Pregnancy a Mother – by 9 months of pregnancy will increase her heart mass by 40% as well as a 25% increase in trabeculations more than our best and most elite sportsmen
  • Note an elite athlete will exercise 10-15 hours a week and rest accordingly
  • A pregnant mother will be ‘exercising’ 24 hours per day 7 days a week for 9 months and increasingly slow with no rest even when she sleeps.
  • We need to acknowledge that pregnancy is a truly Olympian feat.
  • We are not all Olympians – so its not surprising that 10-15% of women struggle to cope with the vascular load of pregnancy.

Symptoms of Pregnancy as you go along:

  • Shortness of breath
  •  Swollen ankles
  • Chronic lack of energy
  • Increased urination at night
  • Difficulty sleeping due to breathing problems
  •  Confusion and memory loss

Is it a coincidence that the symptoms of heart failure are exactly the same as above?


  • In the most severely ill preecclamptic women the function of the heart is that of a 70 year old woman
  • So what is the effect of preeclampsia – mothers tested 2 years after delivery did not who recover their full heart function in the subsequent 2 years.
  • Preeclampsia appears to advance the age related risk of heart disease and high blood pressure by 20 years.

Take home message – if you suffer from preeclampsia then you may have an underlying cardiovascular condition or restriction and you should take measures to rectify this improve heart function/health following the pregnancy as to prevent any CV complications 20-30 years down the line.

To watch the entire Ted Talk click here.

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